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As a physical medicine and rehabilitation physician “specialist” at Kalkaska Memorial Health Center community hospital in rural Northern Michigan, I had become accustomed to being a big fish in a little pond. I was fortunate to be hired full-time, and placed within a primary care practice to help facilitate cross-talk between specialists and generalists. On a regular basis, I had other primary care physician’s curbside with me to review films and patient cases. Interactions were frequent. I loved this role, felt important, and seldom struggled with identity. Our small, but diverse practice had interdisciplinary care including primary care, PM&R, counseling, and psychiatry all in the same hallway. Everything was perfect, that is, until March 2020.
With COVID 19, a lot changed. We needed a “sick hall” to separate the ill from our general population. Since the psychiatrist and I were “specialists” we relocated to the specialty clinic, a space physically separate from the primary care practice. Here I functioned in a specialist silo, others reached into my silo to ask questions and then stepped out as quickly as they had come in. Other specialists functioned in a similar fashion. Some specialists were there on a weekly or monthly basis, and all of us shared our space and our exam rooms.
Then an interesting thing happened. Our hospital system had to reevaluate and prioritize. The ideas of “essential worker” and “critical services” became well known, and definitions changed. One by one specialists were deferred. The term “elective” became synonymous with outpatient specialties. Surgeons didn’t operate because there was a need to conserve spare PPE and there was the initial lack of testing capabilities. I did not have any of my hours furloughed, largely because our rehab unit had expanded as local hospitals were trying to discharge their patients to make room for those with COVID.
Our primary care generalists stepped forward and stepped up! Soon specialists were asking the generalists how to mitigate the spread of the virus, how to safely treat patients, and if we should treat at all. Our community recognized these frontline providers on the radio, on TV, and by placing banners in our hospital parking lot. These “generalists” were now the “specialists”, not to mention heroes in the eyes of many. They knew best how to decrease the spread of the virus and care for those who were sick.
For the last year these generalists guided us and have done a phenomenal job at it! Our specialists are now working, and patient care is a mix of virtual and in-person visits. I have learned that as physicians, we all have unique skills that may be needed in a crisis. We deserve the opportunity to have cross-talk between specialty and primary disciplines. The creation of silos of care diminishes what we can achieve when integrated. I look forward to a return to the primary care clinic, but more than that I look forward to the day that we all realize the need for interdisciplinary integration and cease to separate specialists from generalists. Through this collaborative mindset we can provide the best care possible for our patients. We are all special in the services we provide and can provide them better when we work together.
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